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Mid-term effect of lumbar sustained natural apophyseal glides in patients with non-specific chronic low back pain: a randomized clinical trial
Simsek S, Yagci N, Korkmaz MB
The Eurasian Journal of Medicine 2023 Jun;55(2):152-157
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The objective of this study was to compare the standalone and combined mid-term effects of conventional physiotherapy and lumbar sustained natural apophyseal glides on pain, range of motion, fear avoidance belief, and functional status in patients with non-specific chronic low back pain. MATERIALS AND METHODS: This randomized clinical study was conducted in a state hospital. Fifty-five patients with non-specific chronic low back pain (mean age 40.69 +/- 6.27 years) were divided into 3 groups. Group I (n = 18) received conventional physiotherapy (electrotherapy and heat application) 5 days a week for 3 weeks, group II (n = 19) received lumbar sustained natural apophyseal glides 3 days a week for 3 weeks. Group III (n = 18) received conventional physiotherapy plus lumbar sustained natural apophyseal glides. Pain (visual analog scale), flexion range of motion (back range of motion II), functional status (Roland-Morris Disability Questionnaire), and fear avoidance belief (Fear Avoidance Belief Questionnaire) were assessed at baseline, third week, and 6 month follow-up. RESULTS: After 3 weeks of intervention, all outcome measures improved in groups II and III. These improve- ments remained significant until 6 month follow-up (p < 0.05), except fear avoidance belief (p = 0.06) and flexion range of motion (p = 0.764) scores of group III. Flexion range of motion (p = 0.001), functional status (p = 0.001), and fear avoidance belief (p = 0.03) differed significantly between the 3 groups at 6-month follow-up; post-hoc analysis revealed that flexion range of motion (p < 0.0001), functional status (p = 0.037), and fear avoidance belief (p = 0.002) scores were significantly improved in group II compared to group I. CONCLUSION: Compared with conventional physiotherapy, lumbar sustained natural apophyseal glides improved mid-term range of motion, functional status, and fear avoidance belief, but there was no difference in pain. Conventional physiotherapy added to lumbar sustained natural apophyseal glides provided no additional benefit.

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